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Background and Aims: The venous excess ultrasound (VExUS) score presents a prospect of valuable clinical utility. The study aimed to systematically review the effectiveness of the VExUS score in detecting venous congestion across emergency, critical care, and peri-operative contexts; assessing its utility in improved patient outcomes; and exploring its relationship with established parameters. Methods: This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42023421034). A comprehensive literature search, employing pre-defined search terms related to the VExUS score in diverse clinical contexts, was conducted on articles published between 2000 and 15 May 2023 across databases- PubMed, PubMed Central, Cochrane, Scopus, Elsevier Clinical Key, and Google Scholar. Bias risk assessment was carried out using the Risk of Bias in Non-Randomised Studies tool. Given the significant heterogeneity across studies concerning participants, interventions, outcomes, and study designs, data pooling for a meaningful meta-analysis was not feasible. Results: The review included 15 articles comprising observational studies, case series, and case reports. Most patients exhibited moderate-to-severe venous congestion based on their baseline VExUS scores. Higher VExUS scores correlated with a greater risk of acute kidney injury (AKI) in post-operative patients. The VExUS score strongly correlated with central venous pressure; specific components, such as the intra-renal monophasic pattern, portal-pulsatility, and inferior vena cava diameter, exhibited robust predictive value for venous congestion. Conclusion: VExUS score is valuable in assessing and predicting venous congestion, especially regarding AKI prediction risk and guiding interventions. However, its utility in predicting outcomes in acute heart failure patients appears less certain. Keywords: Intensive care unit, mortality, patient outcomes, peri-operative setting, venous congestion, venous excess ultrasound score, VExUS, Author(s): Bhavna Gupta [1]; Pallavi Ahluwalia [2]; Anish Gupta [3]; Nikhil Ranjan (corresponding author) [4]; Kamna Kakkar [4]; Parag Aneja [1] INTRODUCTION There has been an increase in interest in [...]

Byline: Pallavi. Ahluwalia, Bhavna. Gupta Dear Editor, Appropriate fluid management in the perioperative period is always challenging. Unfortunately, many physicians who use point-of-care ultrasound (POCUS) use inferior vena cava (IVC) [...]

Author(s): Kanni Balakrishnan [1]; Amit Kohli (corresponding author) [2]; Divya Jain [3]; Pallavi Ahluwalia [4] INTRODUCTION ‘Ideal' as a noun means a person or thing regarded as perfect. Over the [...]

Author(s): Bhavna Gupta [1]; Pallavi Ahluwalia (corresponding author) [2] Sir, A research survey is the process of conducting research using a survey and is considered as the easiest way of [...]

Byline: Pallavi. Ahluwalia, Bhavna. Gupta The cancer burden continues to grow globally, exerting tremendous physical, emotional, and financial strain on individuals, families, communities, and health systems. The number of health-related [...]

Byline: Pallavi. Ahluwalia, Bhavna. Gupta Sir, Informed consent is a collaborative decision-making process and the patient's voluntary agreement to accept medical and surgical treatment. Preoperative checkups and informed consent necessitate [...]

Background: Post operative sore throat is a very dreadful and 2nd most common complications in patients undergoing tracheal intubations and is developing as major reason of patient' s dissatisfaction. Incidence of 21-68% has been reported in studies. We compared Magnesium sulphate gargle and nebulization in preventing POST. Materials and Method: After obtaining written informed consent and permission from institutional ethical committee, 70 patients scheduled for surgery under GA were enrolled and equally divided randomly by chit and box method in two groups: Group A: nebulized with 3ml of isotonic Magnesium sulfate for 15 minutes at 5mins before induction of anaesthesia. Group B: Patients were given Magnesium sulfate gargle (20mg/kg in 30ml of 25 % Dextrose water) at 15 minutes before induction of anaesthesia. Haemodynamic parameters -H.R, SBP, DBP, R.R and SpO 2 was measured intraoperatively. After extubation, severity of POST was assessed at 0hr, 2hrs, 4 hrs, 6hrs, 12 hrs, 24hrs and 48 hrs by VAS scale and grading of POST was done by 4 point scale (0-3) and compared between the groups. Results: On comparing the groups, no significant statistical difference was found between haemodynamic parameters. The mean score of POST was significantly more in group N at 2,4,6 and 12 hours (p value-0.001,0.01,0.002 and 0.001).VAS score was observed significantly more in group N patients in compare to group G at 0,2,4,6 and 12 hours after extubation (p value-0.018,0.007,0.012,0.001 and 0.022).No significant complications were found. Conclusion: It was concluded that Magnesium Sulphate relieves sore throat and complaint of cough and hoarseness by both route But Gargle proved to be simple and effective way to reduce POST. [ABSTRACT FROM AUTHOR]

Background: Nerve blocks in inguinal hernia repair will provide analgesia and lessen the requirement of iv. analgesics thereby minimizing side effects and improve VAS score. Materials and Method: The SA block were administered using standard technique. Patient were divided into three groups. Group T: Tap block using ultrasound. Group I: Ilioinguinal/iliohypogastric nerve block using ultrasound. Group L: Infiltration of incision site. VAS scores and hemodynamics were assessed at different time interval. Results: The comparison of Mean among Three group-I, L and T of hemodynamic parameters were found not Significant and VAS score were found Significant. Conclusion: Ultrasound-guided ilioinguinal and iliohypogastric nerve blocks provided better post-operative pain relief than ultrasound-guided TAP block and wound infiltration at the proposed site of incision. [ABSTRACT FROM AUTHOR]

Background and Aim: Due to the lack of motor sparing in adductor canal block and the analgesic effects postoperatively being on par with those of femoral nerve block, it is now regarded as a worthy substitute for femoral nerve block after knee surgeries. In this study, we tested the effectiveness of these 2 commonly used blocks by administering a standard dose of local anaesthetics to patients undergoing all knee surgeries, randomly assigning them to 2 groups, administering one block to each group, and monitoring the quadriceps' motor function and postoperative analgesia in both groups. Materials and Method: Study was done on sixty patients divided into two groups (FN and AC) randomly after getting clearance from Institutional Ethics Committee. For both blocks, 15ml of 0.5% Bupivacaine with 5ml of Epinephrine was given. Demographics of each patient, hemodynamic data recorded intraoperatively, pain score (VAS score), muscle power grading, rescue analgesia and complications were noted and statistically analyzed using various tests. Results: 60 patients in two groups-30 in FN and 30 in AC were evaluated at T4, T5, T6 hours for FN were 3.80, 4.81, 5.6 and AC were 3.91, 5.87, 6.2 (p=0.001, 0.001, 0.032). VAS, rescue analgesia, patient satisfaction were not significant. Conclusion: Adductor canal block showed significant higher grade of strengthening of quadriceps muscle than femoral nerve block postoperatively in 4th, 5th and 6th hour. [ABSTRACT FROM AUTHOR]

Background: Spinal anaesthesia is the most common neuraxial regional block used in surgical procedures providing favourable conditions for lower abdominal surgeries like inguinal hernia repair. The aim of the study is to compare effectiveness of high versus low doses of intrathecal hyperbaric bupivacaine given at different time intervals for inguinal hernia surgeries. Material and Methods: The study was carried out on 90 patients which were randomized in 3 groups of 30 patients each. Group H1 received 10 mg of 0.5% bupivacaine heavy in 2 ml volume intrathecally in sitting position and remained in this position for 1 minute before turning them to supine. Group H2 received similar doses of heavy bupivacaine as H1 but remained in this position for 2 minutes before turning them to supine. Group L0 was given 5 mg of 0.5% bupivacaine heavy diluted to 2 ml volume intrathecally in sitting position and made to lie supine immediately. Onset and duration of sensory and motor block together with haemodynamic parameters and any associated complications/side effects were assessed. Results: On comparing the heart rate between Group L0 and Group H1/H2 statistically significant difference was observed from 5 to 30 minutes (p<0.05). Similar results were obtained while comparing systolic blood pressure between Group L0 and Group H1/H2 from 5 to 30 minutes (p<0.05). However, no significant results were observed on comparing Group H1 and H2 for heart rate and systolic blood pressure at any time interval. Intergroup comparison of Group L0, H1 and H2 revealed statistically significant results in onset/duration of sensory/motor block (p<0.05). Conclusion: The present study revealed that at 1 & 2 minutes sitting position after injecting hyperbaric bupivacaine intrathecally 10 mg in inguinal hernia surgeries results in more haemodynamic stability compared with immediately lying down. [ABSTRACT FROM AUTHOR]

Background: Neuraxial block is the recommended method for caesarean section as general anaesthesia carries higher chances of maternal and foetal morbidity/mortality. The current study comparesintrathecal administration of premixed vs serial injection of fentanyl as an adjuvant drug to low dosage heavy bupivacaine in lower segment caesarean section. Material and Methods: The research involved 70 patients consisting of Group P (35 patients) who received neuraxial block using premixture of 7.5mg(1.5ml) of 0.50% heavy bupivacaine with 25 mcg injection fentanyl in same syringe. However, in Group S (35 patients) the same drug was administered using one syringe without barbotage and 25mcg of fentanyl from other syringe. Block characteristics, hemodynamic parameters, VAS (visual analogue scale), APGAR score and any complications or side effects were noted. Results: On comparing the groups, there was no statistical significance found among hemodynamic parameters. The average duration of sensory blockade was considerably shorter in group S (1.91±0.28) than in group P. (2.63±0.49) (p=0.001). Similar statistically significant results were obtained on comparing onset of sensory block between the groups. Moreover, on comparing onset/duration of motor block statistically significant results were obtained(p<0.05). The results were comparable on comparing VAS and APGAR scores between the groups. Conclusion: Serial injection of fentanyl as an addon drug to low dosage heavy bupivacaine is helpful in quicker onset and extended period of sensory and motor blockade with stable hemodynamic parameters. [ABSTRACT FROM AUTHOR]

When it comes to medical caregiving, palliative care (PC) is a multidisciplinary strategy that has the goal of improving quality of life while also alleviating suffering. The doctrine of care for persons with life threatening or debilitating illnesses, as well as bereavement assistance for their families, is based on an organised, highly structured system of providing care to people with life-threatening or debilitating illnesses for the course of their lives. A coordinated continuum of care must be guaranteed throughout multiple healthcare settings, including the hospital, the patient's home, the hospice and long-term care institutions. It is essential for patients and clinicians to communicate and make decisions jointly. It is the goal of PC to provide pain relief and emotional and spiritual support to patients and the people who care for them. The best way to ensure the plan's success is to have an interdisciplinary multidimensional team of medical professionals, nurses, counsellors, social workers and volunteers coordinate it. Due to the alarming projections of cancer incidence over the next few years, a lack of hospices in developing countries, inadequate inclusion of PC, high out-of-pocket expenses for cancer treatment and the resulting financial burden on families, there is a critical need for PC and cancer hospices. To establish PC services, we stress the importance of the various M principles of management, which are divided into the following categories: Mission, Medium (setting), Men, Material including medications and Machines, Methods, Money and Management. These principles are discussed in greater detail later in this short communication. We believe that if we follow these principles, we will be able to establish PC services ranging from home-based care to the provision of care in tertiary care centres. [ABSTRACT FROM AUTHOR]

Anatomical differences in the airway in pediatric patients, compared to adults pose many challenges during endotracheal intubation, such as selecting the proper sized endotracheal tube (ETT) during intubation. Our primary objective was to assess how accurate is ultrasound (US) co-relation in comparison to standard age-based formulas in pediatric patients. Meta-analysis was registered in PROSPERO 2020, CRD42020220041. Online literature available in PubMed, Cochrane, and Embase, Goggle scholar was searched from year 2000 till November 30, 2020, using relevant Mesh terms, ('airway US' OR (('airway'/exp OR airway) AND ('US'/exp OR US))) AND ('endotracheal intubation'/exp OR 'endotracheal intubation') AND ('pediatric'/exp OR pediatric)" to Predict endotracheal tube size/placement in pediatric age (neonate till 18 years) by the US. Bibliographic cross-references of selected publications were further manually screened. The full texts of each article were studied, once the abstract was found appropriate independently by two reviewers. A total of 48 papers published between 2010 and 2020 were identified as relevant and read in detail. Average numbers of patients were 86 and total numbers of patients were 1978. Most of the studies included pediatric patients posted for elective surgeries under general anesthesia and excluded emergency procedures, known laryngeal or tracheal pathology, high-risk patients, recent upper respiratory tract infections or allergy to ultrasound gel. A total of 18 independent correlations were analyzed. Final combined r value calculated from all the included articles was 0.824 (95% CI 0.677, 0.908) with a P < 0.00001 {strong co-relation (r > 0.80)}. Q statistic of 756.484, and I2 statistics of 97.53% showed a large degree of heterogeneity in the effect size across the studies. Use of US for upper airway in pediatric patients is an effective modality and can effectively predict endotracheal tube size estimations in comparison to standard age-based or height-based formulae in the pediatric age group. US is a non-invasive, cost-effective, portable, and reproducible technique as compared to CT and MRI. It also takes less time with increasing expertise and experience. [ABSTRACT FROM AUTHOR]

Sir, Anesthesiologists all over the world are terrified of risk of stomach regurgitation and pulmonary aspiration, especially in full-term pregnant females, and that is the reason, despite controversies in cricoid pressure application, it is still applicable for conduct of anesthesia for an emergency lower-segment cesarean section (LSCS) under general anesthesia.[[1]] Dr. B.A. Sellick pioneered cricoid pressure (CP), an esophageal occlusion technique used in emergencies and full stomach individuals to reduce gastric regurgitation following tracheal intubation. Real-time assessment of esophageal occlusion by ultrasound-guided paralaryngeal pressure application in emergency LSCS - Time to change practices? Ultrasound-guided occlusion of the esophagus is a more reliable method to prevent the chances of aspiration during rapid sequence induction and emergency intubation. [Extracted from the article]